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. 2018 Feb 9;18:169. doi: 10.1186/s12885-018-4053-y

Characteristics of people living in Italy after a cancer diagnosis in 2010 and projections to 2020

Stefano Guzzinati 1,✉, Saverio Virdone 2, Roberta De Angelis 3, Chiara Panato 2, Carlotta Buzzoni 4,5, Riccardo Capocaccia 6, Silvia Francisci 3, Anna Gigli 7, Manuel Zorzi 1, Giovanna Tagliabue 8, Diego Serraino 2, Fabio Falcini 9, Claudia Casella 10, Antonio Giampiero Russo 11, Fabrizio Stracci 12, Bianca Caruso 13, Maria Michiara 14, Anna Luisa Caiazzo 15, Marine Castaing 16, Stefano Ferretti 17, Lucia Mangone 18, Giuseppa Rudisi 19, Flavio Sensi 20, Guido Mazzoleni 21, Fabio Pannozzo 22, Rosario Tumino 23, Mario Fusco 24, Paolo Ricci 25, Gemma Gola 26, Adriano Giacomin 27, Francesco Tisano 28, Giuseppa Candela 29, Anna Clara Fanetti 30, Filomena Pala 31, Antonella Sutera Sardo 32, Massimo Rugge 1,33, Laura Botta 6, Luigino Dal Maso 2,✉
PMCID: PMC5807846  PMID: 29426306

Abstract

Background

Estimates of cancer prevalence are widely based on limited duration, often including patients living after a cancer diagnosis made in the previous 5 years and less frequently on complete prevalence (i.e., including all patients regardless of the time elapsed since diagnosis). This study aims to provide estimates of complete cancer prevalence in Italy by sex, age, and time since diagnosis for all cancers combined, and for selected cancer types. Projections were made up to 2020, overall and by time since diagnosis.

Methods

Data were from 27 Italian population-based cancer registries, covering 32% of the Italian population, able to provide at least 7 years of registration as of December 2009 and follow-up of vital status as of December 2013. The data were used to compute the limited-duration prevalence, in order to estimate the complete prevalence by means of the COMPREV software.

Results

In 2010, 2,637,975 persons were estimated to live in Italy after a cancer diagnosis, 1.2 million men and 1.4 million women, or 4.6% of the Italian population. A quarter of male prevalent cases had prostate cancer (n = 305,044), while 42% of prevalent women had breast cancer (n = 604,841). More than 1.5 million people (2.7% of Italians) were alive since 5 or more years after diagnosis and 20% since ≥15 years. It is projected that, in 2020 in Italy, there will be 3.6 million prevalent cancer cases (+ 37% vs 2010). The largest 10-year increases are foreseen for prostate (+ 85%) and for thyroid cancers (+ 79%), and for long-term survivors diagnosed since 20 or more years (+ 45%). Among the population aged ≥75 years, 22% will have had a previous cancer diagnosis.

Conclusions

The number of persons living after a cancer diagnosis is estimated to rise of approximately 3% per year in Italy. The availability of detailed estimates and projections of the complete prevalence are intended to help the implementation of guidelines aimed to enhance the long-term follow-up of cancer survivors and to contribute their rehabilitation needs.

Keywords: Cancer prevalence, Projections, Survivors, Italy

Background

Estimates of cancer prevalence are widely based on limited duration prevalence, including only patients living after a cancer diagnosis made in the previous 5 years [1, 2]. Prevalence, regardless of the time since diagnosis (i.e., complete prevalence), is less frequently estimated than limited duration prevalence [3–9]. Overall age-standardized cancer incidence and mortality rates have declined over the past 10 years in the majority of high income countries, whereas the complete prevalence has been consistently increasing in the early 2000s [3, 4, 6, 8, 10, 11]. Complete prevalence is generally measured in absolute numbers and proportions, i.e., not age-standardized. Thus, improved survival [12, 13] and population ageing (increasing absolute number of new cancer diagnoses) imply a progressive increase in tumour prevalence.

Cancer prevalence includes patients currently treated for cancer; those who have become cancer free, but still have a measurable excess risk of recurrence or death; and, finally, patients having death rates similar to those of the general population who can be considered “cured patients” [14]. Many of these individuals are possibly affected by physical, cognitive, and/or psychosocial limitations [15].

The aim of this study was to provide a description of the number of people living in Italy at January 1, 2010 after a cancer diagnosis, for all cancers combined and for a selection of cancer types by sex, age, and time since diagnosis. In addition, projections of cancer prevalence in Italy are presented up to the year 2020. Estimates and projections of complete tumour prevalence and characteristics of prevalent patients are necessary to help clinicians and health care planners in improving long-term care of patients and in allocating appropriately health care resources. Moreover, they may provide helpful information to a growing number of cancer patients or former patients.

Methods

Study design and data sources

This is a descriptive analysis of individual data collected during the period 1976-2009 from 27 population-based Italian cancer registries (i.e., 32% of the entire Italian population in 2010), which agreed to participate in the study and were able to provide at least 7 years of cancer registration as of December 31, 2009 (Appendix 1) and follow-up of vital status as of December 31, 2013. The Italian legislation identifies Cancer Registries as collectors of personal data for surveillance purposes without explicit individual consent. The approval of a research ethic committee is not required, since this descriptive study was conducted without any direct or indirect intervention on patients.

Prevalence for all malignant tumours (ICD-10: C00-C43, C45-C96) and 34 cancer types or their combinations were estimated and presented in this study for all age groups. Urinary bladder cancers with benign or uncertain behaviour, and in situ tumours were also included. Only non melanoma skin cancers (ICD-10 C44) were excluded. ICD-O-3 morphology codes were used to define specific subtypes.

Statistical methods

The clinical and demographic characteristics of the persons registered with a diagnosis of cancers in the Italian CRs were used to estimate: 1) how many of them were still alive at January 1, 2010 regardless of time since diagnosis -i.e., complete prevalence count- by cancer type, sex, and age group; 2) the prevalence proportion in Italy at 2010 for each cancer type, by sex, and age; 3) the complete prevalence (count and proportion) at 1st January 2015 and 2020, overall and by time since diagnosis; and 4) describe the changing over time of these estimates.

For each cancer registry we computed the limited duration prevalence, i.e. the number of patients diagnosed in the period of the registration activity (between 7 and 34 years) at January 1, 2010, using the counting method implemented in SEER*Stat software [16]. This maximum limited duration prevalence was corrected, using the COMPREV software [17], by means of completeness index [18, 19], to estimate the total number of cancer patients alive, regardless of when they were diagnosed. Completeness indices were estimated by cancer type, sex, age, and time since diagnosis. Prevalence was computed as an absolute number, as well as a proportion per 100,000 residents people by cancer type, sex, age group, area of residence, and years since diagnosis. Patients with more than one primary cancer were included in the computation of prevalence for each cancer type or combination. In the analyses for all types combined, only the first cancer was considered. Completeness indices were obtained by statistical regression models of incidence and survival using data from 8 long-term registries (Appendix 1) with an available observation period of at least 18 years before 2010 [20, 21]. Relative survival and incidence functions were estimated by means of parametric models within the period 1985-2011 for survival and 1985-2009 for incidence. The survival model was a parametric cure model assuming that a proportion of individuals with cancer were bound to die (fatal cases) with a survival following a Weibull distribution, while the remaining proportion (cured fraction) had the same mortality rate as that of the general population with the same age and gender stratification [14, 20]. The parameters of the survival model were estimated by cancer type, sex, and age class (0-14, 15-44, 45-54, 55-64, 65-74, 75+ years) through the SAS procedure NLIN. A period effect was included on the hazard of dying of cancer. Incidence data were categorised according to cancer type, sex, five-year age group, and birth cohort (< 1899, 1900-1904,…, 2005-2009). A sixth degree polynomial age-cohort model of crude incidence rates was fitted through the SAS LOGISTIC procedure for each cancer type and sex [21].

Complete prevalence proportions were projected to 2020 by cancer type, sex, age, and registry, assuming that complete prevalence will follow a linear function, based on the trend of the last three calendar years (i.e., 2007-2009). This simplified assumption (linear and constant trend) may not be valid for long-term projections, but it is reasonable for short or medium-term (e.g., 10-year) ones. Other assumptions (e.g., log-linear models) were explored [4, 6], showing consistent results for common cancer types, but unstable projections for the rarest.

The absolute number of prevalent cases in Italy was obtained using proportions of prevalence estimates (age-, sex-, and cancer type-specific) from CRs included in this study, multiplied by the Italian national population by sex and age observed at January 1, 2010. Proportions projected to 2020 were thus multiplied to Italian population forecasted at January 1, 2020 [22].

Results

Prevalence estimates at 2010

In Italy in 2010, 2,637,975 persons were alive after a cancer diagnosis, corresponding to 4.6% of all the Italian population (Appendix 2). Prevalence proportions increase with age: 3.1% at age 45-54 years, 6.6% at 55-64 years, 12.1% at 65-74 years, and nearly 17% after age 75 years (Appendix 2) with differences by sex (Tables 1 and 2).

Table 1.

Complete cancer prevalence by cancer type and age in Italian men at January 1, 2010

Cancer type Prevalent cases Prevalence proportion per 100,000 men
All ages % 00-14 15-44 45-54 55-64 65-74 75-84 85+ All ages 00-14 15-44 45-54 55-64 65-74 75-84 85+
All types but skin non-melanoma 1,194,033 4844 84,172 87,091 198,505 363,932 357,051 98,439 4250 111 732 2079 5715 13,029 20,534 21,955
Upper aero-digestive tract 26,745 2.2% 19 1654 3320 6536 8063 5786 1367 100 0 15 84 199 311 337 313
Esophagus 3067 0.3% 0 54 252 722 1105 781 153 12 0 1 7 23 45 51 40
Stomach 45,970 3.8% 2 764 2583 6661 13,618 16,538 5802 158 0 6 58 180 470 926 1268
Small intestine 3384 0.3% 0 221 350 760 987 850 216 13 0 2 8 23 38 52 46
Colon, rectum, anus 185,532 15.5% 3 2718 8722 29,332 59,931 63,698 21,130 654 0 23 210 840 2108 3618 4682
Liver 17,454 1.5% 57 317 1539 3831 6347 4752 610 63 2 3 37 110 228 280 142
Biliary tract 4251 0.4% 0 70 238 713 1365 1443 421 15 0 0 6 20 47 80 103
Pancreas 5856 0.5% 3 198 598 1383 1876 1462 336 21 0 2 14 39 69 84 75
Larynx 44,810 3.8% 0 236 2105 8399 15,082 14,819 4169 160 0 2 51 240 540 854 965
Lung 63,048 5.3% 16 804 2771 11,014 22,765 21,682 3996 219 0 7 64 306 787 1229 890
Thymus, heart, mediastinum 2290 0.2% 42 384 435 548 516 331 33 7 1 3 9 14 18 18 9
Bone 4808 0.4% 152 1910 924 771 596 418 37 16 3 16 20 21 19 22 10
Skin melanoma 44,977 3.8% 21 6730 7411 9817 11,117 7867 2014 165 0 61 181 291 408 470 488
Mesothelioma 2090 0.2% 0 72 127 457 913 466 54 8 0 1 3 13 34 27 12
Kaposi sarcoma 5611 0.5% 3 567 658 864 1255 1498 766 21 0 5 17 26 46 90 174
Connective tissue 11,757 1.0% 226 2685 1696 2043 2459 2002 647 41 6 23 41 59 87 111 144
Penis 4285 0.4% 0 91 413 795 1309 1255 422 14 0 1 9 22 45 68 84
Prostate 305,044 25.5% 3 438 3387 34,764 112,958 122,376 31,118 1112 0 5 88 1048 4138 7143 6878
Testis 37,937 3.2% 86 17,116 8495 5349 3317 2389 1187 133 2 149 197 152 128 133 243
Kidney 62,815 5.3% 314 2842 5609 12,652 19,613 17,524 4262 226 7 25 134 364 703 1030 984
Bladder 192,611 16.1% 25 2802 8582 28,948 59,204 70,749 22,302 686 0 26 204 821 2104 4074 5053
Choroidal melanoma 1801 0.2% 0 115 209 365 484 519 109 7 0 1 6 11 18 30 25
Brain and central nervous system 16,110 1.3% 568 5391 2881 2930 2525 1423 391 54 13 46 65 81 82 78 66
Thyroid 25,512 2.1% 31 6428 5811 5876 4665 2351 349 89 1 56 137 165 166 136 80
Hodgkin lymphoma 27,821 2.3% 165 9685 5488 5229 4133 2684 437 95 4 83 129 139 141 148 99
Non-Hodgkin lymphoma 56,808 4.8% 629 8344 8754 11,691 13,802 11,185 2403 203 14 72 206 339 501 655 574
Leukemias 36,105 3.0% 1939 7620 4086 5656 8050 6703 2051 124 43 65 94 158 276 373 444
Multiple myeloma (plasma cell) 12,787 1.1% 0 326 1158 2636 4050 3680 938 45 0 3 27 75 143 215 207
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Table 2.

Complete cancer prevalence by cancer type and age in Italian women at January 1, 2010

Cancer type Prevalent cases Prevalence proportion per 100,000 women
All ages % 00-14 15-44 45-54 55-64 65-74 75-84 85+ All ages 00-14 15-44 45-54 55-64 65-74 75-84 85+
All types but skin non-melanoma 1,443,942 3903 112,527 176,656 277,374 363,646 357,146 152,690 4836 93 988 4095 7496 11,243 13,994 14,500
Upper aero-digestive tract 15,433 1.1% 19 1562 1687 3156 3696 3624 1688 54 0 14 41 87 123 148 158
Esophagus 1125 0.1% 0 17 102 199 348 358 101 4 0 0 3 6 13 16 11
Stomach 35,537 2.5% 0 651 1896 3992 8619 12,953 7426 117 0 5 41 104 254 497 698
Small intestine 2597 0.2% 0 136 277 495 688 752 250 9 0 1 6 14 21 29 28
Colon, rectum, anus 171,847 11.9% 12 2754 8640 24,517 45,322 59,479 31,123 571 0 24 204 658 1377 2287 2901
Liver 7331 0.5% 61 258 371 943 2182 2926 589 25 1 2 9 25 68 114 58
Biliary tract 5565 0.4% 3 60 286 836 1517 1932 931 18 0 0 6 22 44 72 84
Pancreas 6271 0.4% 0 326 495 1239 1699 1733 780 21 0 3 11 33 55 68 69
Larynx 4407 0.3% 2 68 364 898 1211 1358 508 16 0 1 8 26 41 55 52
Lung 23,721 1.6% 5 611 2373 4933 7158 6662 1980 80 0 6 53 133 224 268 186
Thymus, heart, mediastinum 2212 0.2% 61 514 406 410 443 306 72 7 2 4 9 9 12 11 7
Bone 9124 0.6% 100 2259 2163 1950 1306 973 374 28 3 19 43 47 38 38 32
Skin melanoma 57,515 4.0% 30 10,718 9929 10,950 11,657 9953 4278 198 1 98 237 302 372 404 432
Mesothelioma 674 0.0% 0 18 68 148 224 174 42 2 0 0 2 4 8 8 5
Kaposi sarcoma 1990 0.1% 0 105 60 197 349 750 528 7 0 1 2 6 12 30 49
Connective tissue 9917 0.7% 203 1893 1399 1812 1890 1791 929 34 5 17 32 49 62 71 91
Breast 604,841 41.9% 0 26,663 82,068 128,514 165,456 142,658 59,483 2046 0 236 1906 3516 5164 5643 5751
Vagina and vulva 9689 0.7% 17 256 557 982 2377 3570 1931 32 0 2 13 27 71 137 183
Cervix uteri 58,879 4.1% 4 4321 8073 10,569 13,177 15,641 7093 193 0 38 184 280 397 591 675
Corpus uteri (endometrium) 103,321 7.2% 0 1490 5745 21,047 31,548 31,158 12,333 342 0 13 135 553 964 1198 1147
Ovary 45,620 3.2% 65 4058 6617 10,544 11,399 9729 3209 149 1 34 154 276 352 372 291
Kidney 35,250 2.4% 411 2369 2841 5290 9461 10,650 4229 122 9 21 68 149 293 436 418
Bladder 47,822 3.3% 6 1362 2562 6101 11,410 16,786 9594 164 0 12 62 172 359 676 897
Choroidal melanoma 1713 0.1% 0 149 210 294 445 414 202 6 0 1 4 9 14 18 21
Brain and central nervous system 23,145 1.6% 501 6210 3661 3565 3875 3978 1355 72 12 52 82 96 114 133 105
Thyroid 93,341 6.5% 68 22,813 21,805 21,597 16,956 8578 1524 307 2 199 498 571 521 356 153
Hodgkin lymphoma 20,433 1.4% 102 9116 3990 3104 2222 1401 498 67 2 79 93 84 67 58 43
Non-Hodgkin lymphoma 53,907 3.7% 262 5635 6626 10,917 13,615 12,731 4120 181 6 49 153 290 422 505 407
Leukemias 31,196 2.2% 1450 7445 3465 4400 5626 6067 2742 101 34 64 78 115 166 235 256
Multiple myeloma (plasma cell) 12,278 0.9% 0 217 887 2367 3611 3814 1382 41 0 2 22 64 112 150 124
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Men living in Italy after a cancer diagnosis in 2010 were 1,194,033, corresponding to 4.3% (4250/100,000) of all Italian male population (Table 1). This proportion increased from less than 1% below the age of 45 years, to > 20% for men aged ≥75 years. The most frequent tumours in terms of prevalence were prostate (305,044 of prevalent cases at January, 1st 2010) representing 25.5% of all cases or 1.1% of all Italian men, followed by bladder (192,611 men, 16.1%) and colorectal (185,532 men, 15.5%) tumours.

Italian women living after a cancer diagnosis were 1,443,942 (Table 2), corresponding to 4.8% of all Italian women. Breast cancer represented 41.9% of all cancers (604,841), followed by colorectal cancers (171,847, 11.9% of all female prevalent cases, 0.6% of all Italian women) and by endometrial cancers (103,321, 7.2% and 0.3%, respectively). Notably, the fourth most frequent cancer type diagnosed in Italian prevalent women is thyroid (93,341 women, 6.5% of all female prevalent cases). Prevalent women were younger than men. Women aged 15-44 years living after a diagnosis represented 1% of the whole Italian population, they were 4% at ages 45-54 years, 7% at ages 55-64 years, 11% at ages 65-74 years, and 14% for women aged ≥75 years (Table 2).

More than 1.5 million people (i.e., 2.7% of all Italian residents) were alive after ≥5 years since diagnosis. They were 60% of all prevalent cases, 64% of women and 55% of men. The distribution of prevalent cases by time since diagnosis depends on cancer type (Fig. 1). The percentage of prevalent cases diagnosed since less than 2 years varied from 39% for lung cancer patients to 15% for female breast and 7% for cervical cancer patients. Conversely, the percentage of prevalent cases diagnosed ≥15 years before was 59% for cervical cancer, 35% for stomach cancer and 31% for endometrial cancer, but only 4% for prostate and 13% for lung cancer patients. Notably, patients diagnosed ≥15 years before were 21% of all prevalent cases (16% among men and 25% among women).

Fig. 1.

Fig. 1

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Complete prevalence by time since diagnosis for selected cancer types* in Italy at January 1, 2010. *Cancer types diagnosed in > 50,000 persons, sorted by number of cases

Prevalence projections for 2020

In 2020, there will be 3.6 million prevalent cancer cases in Italy (Table 3), 1.9 million women and 1.7 million men, with a 10-year increase of 37% (41 and 33% in men and women, respectively). In 2020, 2.6% of all Italian women (0.8 millions) will be alive after a breast cancer diagnosis and more than half a million patients (2.1% of all men) will be alive after a prostate cancer diagnosis (Table 3). The largest 10-year increases are foreseen for prostate (+ 85%) and for thyroid cancers (+ 79%, 212,863 cases), which will become the third most frequent prevalent cancer types among Italian women. A more than 50% increases are also expected in 2020 for prevalence after diagnosis of testicular cancer (63,395 patients) or skin melanoma (169,900). A limited change in prevalence (variations < 10%) is expected for ovary, larynx, and stomach, with cervical cancer being the only cancer type showing a decline in prevalence (− 13%) (Table 3).

Table 3.

Projected complete prevalence (cases) at January 1,  2020 by sex and 10-year variations in Italy

Prevalent cases Variation (%)
2020 10-year period
Cancer Typea Men Women Total Men Women Total
All types but skin non-melanoma 1687,049 1,922,086 3,609,135 41.3% 33.1% 36.8%
Upper aero-digestive tract 36,081 21,831 57,911 34.9% 41.5% 37.3%
Stomach 50,327 32,033 82,360 9.5% −9.9% 1.0%
Colon, Rectum, Anus 280,277 233,245 513,522 51.1% 35.7% 43.7%
Liver 25,234 8531 33,765 44.6% 16.4% 36.2%
Larynx 47,015 6006 53,020 4.9% 36.3% 7.7%
Lung 77,159 40,657 117,816 22.4% 71.4% 35.8%
Skin Melanoma 80,069 89,831 169,900 78.0% 56.2% 65.8%
Connective Tissue 17,040 11,815 28,855 44.9% 19.1% 33.1%
Female Breast 834,154 834,154 37.9% 37.9%
Cervix Uteri 51,136 51,136 −13.2% −13.2%
Corpus Uteri (endometrium) 122,553 122,553 18.6% 18.6%
Ovary 49,807 49,807 9.2% 9.2%
Prostate 563,960 563,960 84.9% 84.9%
Testis 63,395 63,395 67.1% 67.1%
Kidney 97,249 47,151 144,400 54.8% 33.8% 47.2%
Bladder 255,015 58,608 313,624 32.4% 22.6% 30.4%
Brain and central nervous system 23,505 29,314 52,819 45.9% 26.7% 34.6%
Thyroid 45,949 166,914 212,863 80.1% 78.8% 79.1%
Hodgkin Lymphoma 37,692 29,314 67,006 35.5% 43.5% 38.9%
Non- Hodgkin Lymphoma 82,780 73,584 156,364 45.7% 36.5% 41.2%
Leukaemias 45,880 39,100 84,980 27.1% 25.3% 26.3%
Multiple Myeloma 19,472 17,159 36,631 52.3% 39.8% 46.1%
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a Cancer types with more than 20,000 prevalent cases at 2010

Nearly 22% (21,657/100,000) of population aged ≥75 years in 2020 will have had a previous cancer diagnosis (Table 4). Below 45 years of age, prevalent cases will be 228,145 (i.e., 0.8% of all cases, 726/100,000) and, in both sexes, the most frequent cancer type will be thyroid cancer, experienced by 31,971 women and 9141 men.

Table 4.

Projected complete prevalence at January 1, 2020 by sex and age groups in Italy a

SEX, Cancer type Prevalent cases Prevalence proportion per 100,000
All ages % 00-44 45-74 75+ All ages 00-44 45-74 75+
MEN and WOMEN
 All types but skin non-melanoma 3,609,135 100.0% 228,145 1,897,543 1,483,448 5731 726 16,383 21,657
 Colon, rectum, anus 513,522 14.2% 4954 231,800 276,767 808 15 2080 3952
 Skin melanoma 169,900 4.7% 24,038 101,180 44,682 271 76 857 673
 Female breast 834,154 23.1% 29,758 498,614 305,781 2622 201 8215 7297
 Corpus uteri (endometrium) 122,553 3.4% 1707 65,765 55,081 379 10 1104 1269
 Prostate 563,960 15.6% 1174 255,514 307,272 2056 12 5634 12,343
 Bladder 313,624 8.7% 4130 128,332 181,162 563 15 1323 2836
 Thyroid 212,863 5.9% 41,112 145,562 26,189 309 127 1084 379
 Non-Hodgkin lymphoma 156,364 4.3% 14,948 87,255 54,161 247 47 739 789
MEN
 All types but skin non-melanoma 1687,049 100% 95,056 834,967 757,026 5444 615 15,678 28,728
 Colon, rectum, anus 280,277 16.6% 2250 135,206 142,821 902 13 2573 5267
 Skin melanoma 80,069 4.7% 8760 50,437 20,872 256 57 898 815
 Prostate 563,960 33.4% 1174 255,514 307,272 2056 12 5634 12,343
 Bladder 255,015 15.1% 2636 106,086 146,294 958 20 2323 5932
 Thyroid 45,949 2.7% 9141 31,444 5364 142 59 490 209
 Non-Hodgkin lymphoma 82,780 4.9% 8959 49,513 24,309 271 58 871 946
WOMEN
 All types but skin non-melanoma 1,922,086 100% 133,089 1,062,575 726,422 5992 888 17,374 17,007
 Colon, rectum, anus 233,245 12.1% 2704 96,594 133,947 720 17 1633 3105
 Skin melanoma 89,831 4.7% 15,278 50,742 23,811 284 102 822 581
 Breast 834,154 43.4% 29,758 498,614 305,781 2622 201 8215 7297
 Corpus uteri (endometrium) 122,553 6.4% 1707 65,765 55,081 379 10 1104 1269
 Bladder 58,608 3.0% 1494 22,246 34,868 195 10 405 859
 Thyroid 166,914 8.7% 31,971 114,119 20,825 508 218 1761 516
 Non-Hodgkin lymphoma 73,584 3.8% 5989 37,743 29,852 225 37 618 688
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a Most frequent cancer types are shown: Cancer types or combinations with > 100,000 prevalent cases

Prevalent cases diagnosed within 2 years were the only group showing a negligible increase from 2010 to 2020 (+ 3% in the examined period), while a 19% increase was observed for cases diagnosed between 2 and 5 years before, 30-34% for cases diagnosed between 5 and 20 years earlier, and 45% increased for long-term survivors diagnosed ≥20 years before (Fig. 2).

Fig. 2.

Fig. 2

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Complete cancer prevalence (proportions) in Italy from 2006 to 2020 by years since diagnosis. *Data for 2006 obtained from ref. 21. Filled symbols (e.g., •) represent estimated values, empty symbols (e.g., ο) represent projected values

Discussion

In 2010, 2.6 million people were living in Italy after a cancer diagnosis and this number will reach 3.6 million in 2020, increasing from 4.6% to 5.7% (i.e., one out of 17 Italians) of the overall population. The estimated overall trend in the present decade in Italy (+ 3.2% per year) is comparable to that estimated in the same period in the USA (+ 2.8% per year) [5], UK (+ 3.3%) [4], and Switzerland (+ 2.5%) [6].

The expected 37% increase in the present decade in Italy will be more marked (i.e., nearly + 50%) among long-term survivors diagnosed ≥20 years before; they will be more than half a million in Italy (519,356), 14% of all prevalent cases (11% in men and 18% in women). Most of them can be considered as cured since they had already reached a similar life expectancy (i.e., death rates) of the corresponding general population [14].

A higher proportion of women (55%) than that of men emerged among prevalent cancer cases at 2010 in the present Italian study, in agreement with findings from most studies conducted in other countries [4–6, 9] but France (where 53% were men, 6.4% of the French population) [8]. In Italy, female breast cancer cases represented 23% of all prevalent cases, and affected the distribution of cancer prevalence by age. The thyroid cancer epidemic in Italy also contributed to an excess in females, below age 45 years thyroid cancer was the most frequent prevalent type in 2010 (29,340 men and women), and this number will substantially increase to more than 41,000 in 2020. It should be noted, however, that a large proportion of thyroid cancer incidence and prevalence may be affected by overdiagnosis; i.e., the detection of cancer cases that would not otherwise result in causing symptoms or deaths [23, 24].

An important role on variation of cancer prevalence is played by screening programmes, inducing a reduction of cervical and colorectal prevalent cancers cases, while early detection of breast and prostate cancers may inflate number of prevalent cases [25]. In particular, screening can prevent cervical cancer, with a consequent major effect on prevalence reduction, i.e., − 13% in 10 years in the present study.

Distribution of cancer prevalence by age is also noteworthy. In 2010, 37% of prevalent patients were 75 years or older (38% in men, 35% in women). In this age group, they will reach 41% in 2020, with more than 20% of men and 14% of women will have experienced a previous cancer diagnosis. These proportions were similar to those reported by other studies, showing also that elderly cancer patients had more severe comorbidity conditions than non cancer patients [26].

At the opposite end of the age spectrum, 8% of Italian prevalent cases were younger than 44 years of age and 10% were aged 45–54 years. It has been recently estimated that 44,135 persons living in Italy in 2010 had had a cancer diagnosis during childhood [27]; they represented 0.07% of the Italian population and 1.7% of prevalent cases diagnosed at any age. In similar studies conducted in the USA [28], a substantial proportion of morbidities emerged in childhood cancer patients several years after diagnosis, and there is growing awareness on potentially long-term risks affecting the survivors’ future physical, cognitive, and/or psychosocial health [29]. The impact of a cancer diagnosis is rather different between younger and older survivors, the first facing more pronounced socio-economic consequences [30, 31], as well as psychosocial impairments in fertility and sexuality [32, 33].

We acknowledge the several limitations of our analyses. First, data from Italian cancer registries (AIRTUM) included one third of the Italian population in 2010 and the representativeness for the national prevalence estimates may be questionable [34]. To overcome this issue, we adjusted estimated proportions in cancer registry areas for the age distribution of the whole Italian population. Moreover, since cancer registries have been active in Italy from a relatively recent time period, the complete prevalence has been estimated through statistical models. Notably, the validation of complete prevalence estimation by means of COMPREV method in Italy and elsewhere [19] is reasonably reassuring. In particular, the validation of COMPREV method shows negligible (i.e., < 5%) differences, when comparing observed prevalence for cancer registries with ≥30 years of observation and estimated prevalence using complete indexes applied to the same registries and truncated data [21, page 34].

On the other hand, the strengths of this population-based study are represented by the size of the study population, which included nearly 1.7 million incident cancer cases, and its long-term follow-up, more than a half of these cases were followed-up for > 20 years post diagnosis. In addition, data and period used were updated in the present study (see Appendix 1), including an additional number of years of observation and follow-up, in comparison with previous studies on the same topic [21].

The accuracy of future projections of prevalence is necessarily uncertain and lies on statistical models based on assumptions reflecting unknown evolution of incidence, survival, and demographic changes. This may also affect comparisons with trends reported in other countries, obtained using different assumptions and statistical models [4, 6, 26]. In our medium-term projections, the hypothesis that complete prevalence at 2020 can be predicted by a linear function of calendar year as regressor variable is supported by empirical evidence, at least for all cancer types combined and for most frequent cancer types, consistently showing an approximate linear trend in recent years [5, 21]. Notably, the use of a longer period (5 calendar years) to estimate linear slope did not materially modify the estimates.

Detailed estimates and projections of numbers of persons living after different cancer diagnoses are particularly relevant for policy makers to better plan health care resource allocation and meet cancer patients needs, including not only initial treatment, but also rehabilitation and long-term surveillance. However, to date, guidelines pertaining to survivorship care have been largely based on consensus rather than on empirical evidence [35–37].

In the USA, the main driver of cancer costs growth is population ageing, with an overall increase of 27% by the year 2020 from 2010 levels [38]. The largest increase in expenditures is attributable to the continuing phase of care (i.e., > 1-year post-diagnosis and > 1 year from death) for prostate and female breast cancer, with 42 and 32% increase respectively [38]. Although health care costs in the continuing phase of care is lower than in the first course of treatment (first year since diagnosis) and in the last year of life, the large number of survivors in the continuing phase of care is driving most of healthcare resources. Similar findings, on the distribution of cancer burden by phase of care, are expected in Italy [39].

Conclusions

The availability of reliable and accurate estimates of complete prevalence and predictions of the rising tide of people living after cancer diagnosis may be helpful not only to epidemiologists and health-care planners, but also to clinicians in developing guidelines to enhance and standardize the long-term follow-up of cancer survivors. Furthermore, these estimates are intended for patients to help recovering social activities and supporting rehabilitation demands.

Acknowledgements

The authors thank Mrs. Luigina Mei for editorial assistance.

Funding

The study was funded by the Italian Association for Cancer Research (AIRC) (grant no. 16921). Role of funding source: The funding sources had no role in study design, collection, analysis or interpretation of data, the writing of the report, or the decision to submit the article for publication.

Availability of data and materials

Dataset supporting our findings is available, according to AIRTUM guidelines, at the following website: www.registri-tumori.it.

Appendix 1

Population and incident cases in Italian cancer registries with ≥7 years of registration in period 1976-2009

CANCER REGISTRY Period of activity Population at January 1st 2010 Incident cases up to 2009a
Period of registration Years included to 2009 (per 1000)
Alto Adige - Sudtirol 1995–2010 15 494 37,119
Biella 1995–2010 15 185 20,362
Catania-Messina 2003–2011 7 1727 58,753
Catanzaro 2003–2009 7 230 7755
Como 2003–2011 7 577 24,963
Ferrarab 1991–2011 19 354 50,925
Friuli Venezia Giulia 1995–2010 15 1219 128,738
Genovab 1986–2009 24 592 112,812
Latina 1996–2011 14 531 32,330
Mantova 1999–2010 11 404 27,541
Milano 1999–2010 11 1215 103,283
Modenab 1988–2011 22 676 84,155
Napoli 1996–2011 14 561 28,250
Nuoro 2003–2011 7 219 7889
Palermo 2003–2011 7 1239 40,926
Parmab 1978–2011 32 420 80,744
Ragusab 1981–2011 29 303 31,283
Reggio Emilia 1996–2011 14 508 41,379
Romagna 1993–2011 17 1058 119,458
Salerno 1996–2009 14 1089 63,293
Sassarib 1992–2011 18 467 37,988
Siracusa 1999–2011 11 400 18,927
Sondrio 1998–2011 12 181 13,003
Trapani 2002–2009 8 429 15,591
Umbria 1994–2011 16 875 85,138
Vareseb 1976-2011 34 860 137,184
Venetob 1990–2009 20 2097 245,898
All CRs 18,909 1,655,687
Italy 59,190
Open in a new tab

a All types but skin non-melanoma

b CRs included to estimate model-based incidence and survival (47% of all cancer cases)

Appendix 2

Complete cancer prevalence (cases and proportion) by cancer type and age at prevalence in Italian men and women at  January 1, 2010

Cancer type Prevalent cases Prevalence proportion ×  100,000a
All ages % 00-14 15-44 45-54 55-64 65-74 75-84 85+ All ages 00-14 15-44 45-54 55-64 65-74 75-84 85+
All types but skin non-melanoma 2,637,975 8747 196,699 263,746 475,879 727,578 714,197 251,129 4552 102 859 3103 6635 12,068 16,620 16,700
Upper aero-digestive tract 42,178 1.6% 38 3216 5007 9692 11,759 9410 3055 76 0 14 62 142 209 224 204
Esophagus 4192 0.2% – 71 354 921 1453 1139 254 8 – 0 5 15 28 30 20
Stomach 81,507 3.1% 2 1415 4479 10,654 22,237 29,491 13,229 137 0 6 49 141 354 669 866
Small intestine 5981 0.2% – 356 627 1255 1675 1602 466 11 – 2 7 18 29 38 33
Colon, rectum, anus 357,379 13.5% 15 5472 17,362 53,849 105,252 123,177 52,253 611 0 23 207 746 1715 2821 3426
Liver 24,785 0.9% 119 575 1910 4774 8529 7678 1199 43 1 3 23 66 142 180 83
Biliary tract 9816 0.4% 3 131 524 1549 2882 3375 1352 16 0 0 6 21 45 75 90
Pancreas 12,128 0.5% 3 524 1093 2622 3575 3194 1116 21 0 2 12 36 61 75 71
Larynx 49,217 1.9% 2 304 2469 9297 16,293 16,177 4676 86 0 1 29 129 271 376 321
Lung 86,769 3.3% 21 1415 5144 15,947 29,923 28,343 5976 147 0 6 58 216 484 654 394
Thymus, heart, mediastinum 4501 0.2% 103 898 842 958 959 636 105 7 1 3 9 11 15 14 8
Bone 13,932 0.5% 251 4168 3087 2721 1902 1391 411 22 3 17 32 34 29 32 26
Skin melanoma 102,492 3.9% 52 17,448 17,339 20,767 22,774 17,820 6292 182 1 80 210 296 388 430 448
Mesothelioma 2763 0.1% – 90 195 605 1137 640 96 5 – 0 2 8 20 15 7
Kaposi sarcoma 7601 0.3% 3 672 718 1061 1605 2248 1294 14 0 3 9 16 27 54 86
Connective tissue 21,674 0.8% 429 4578 3095 3855 4349 3793 1576 37 6 20 37 54 74 87 107
Female breast 604,841 22.9% – 26,663 82,068 128,514 165,456 142,658 59,483 2046 – 236 1906 3516 5164 5643 5751
Vagina and vulva 9689 0.4% 17 256 557 982 2377 3570 1931 32 0 2 13 27 71 137 183
Cervix uteri 58,879 2.2% 4 4321 8073 10,569 13,177 15,641 7093 193 0 38 184 280 397 591 675
Corpus uteri (endometrium) 103,321 3.9% – 1490 5745 21,047 31,548 31,158 12,333 342 – 13 135 553 964 1198 1147
Ovary 45,620 1.7% 65 4058 6617 10,544 11,399 9729 3209 149 1 34 154 276 352 372 291
Penis 4285 0.2% – 91 413 795 1309 1255 422 14 – 1 9 22 45 68 84
Prostate 305,044 11.6% 3 438 3387 34,764 112,958 122,376 31,118 1112 0 5 88 1048 4138 7143 6878
Testis 37,937 1.4% 86 17,116 8495 5349 3317 2389 1187 133 2 149 197 152 128 133 243
Kidney 98,065 3.7% 725 5211 8450 17,941 29,073 28,174 8491 172 8 23 101 253 483 674 585
Bladder 240,433 9.1% 31 4164 11,144 35,049 70,614 87,535 31,896 416 0 19 132 485 1165 2041 2123
Choroidal melanoma 3514 0.1% – 264 419 658 929 933 311 6 – 1 5 10 16 23 22
Brain and central nervous system 39,255 1.5% 1069 11,602 6542 6495 6400 5401 1746 63 13 49 74 89 99 111 94
Thyroid 118,853 4.5% 99 29,241 27,617 27,474 21,622 10,929 1872 202 1 127 321 375 357 268 131
Hodgkin lymphoma 48,254 1.8% 266 18,801 9478 8333 6355 4085 935 81 3 81 111 110 101 94 59
Non-Hodgkin lymphoma 110,715 4.2% 891 13,979 15,380 22,608 27,417 23,916 6523 191 10 61 179 314 458 565 456
Leukemias 67,301 2.6% 3389 15,065 7551 10,057 13,676 12,770 4793 112 39 64 86 136 217 291 312
Multiple myeloma (plasma cell) 25,066 1.0% – 542 2044 5003 7662 7494 2320 43 – 2 24 69 126 176 149
Open in a new tab

a For sex-specific types proportions were also sex-specific

Authors’ contributions

SG and LDM drafted the study protocol, designed the study, and drafted the manuscript with the support of RDA. All authors (SG, SV, RDA, CP, CB, RC, SiF, AnG, MZ, GT, DS, FF, CC, AGR, FaS, BC, MM, ALC, MC, StF, LM, GR, FlS, GM, FaP, MF, RT, PR, GG, AdG, FT, GC, ACF, FiP, ASS, MR, LB, LDM) and AIRTUM Working Group revised the study protocol, collected data, prepared raw data for the study database, and corrected data after quality controls. SG did the statistical analyses with the support of SV, CP, LB and LDM. DS, RC, SiF, AG specifically supported LDM in the interpretation and clinical implication of study results. All authors revised the preliminary results and the report, and contributed to data interpretation, report writing, and reviewed and approved the final version.

Ethics approval and consent to participate

The Italian legislation identifies Cancer Registries as collectors of personal data for surveillance purposes without explicit individual consent. The approval of a research ethic committee is not required, since this study is a descriptive analysis of individual data without any direct or indirect intervention on patients (Decreto del Presidente del Consiglio dei Ministri, 3/3/2017, Identificazione dei sistemi di sorveglianza e dei registri di mortalità, di tumori e di altre patologie, 17A03142, GU Serie Generale n.109 del 12-05-2017 (Available at: http://www.gazzettaufficiale.it/eli/id/2017/05/12/17A03142/sg, last access: 31/01/2018).

Consent for publication

Not applicable

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Footnotes

Adriano Giacomin is deceased.

Change history

08/16/2021

The tagging of the family name of Luigino Dal Maso has been updated.

Contributor Information

Stefano Guzzinati, Email: stefano.guzzinati@regione.veneto.it, Email: registro.tumori@regione.veneto.it.

Saverio Virdone, Email: saverio.virdone@gmail.com.

Roberta De Angelis, Email: roberta.deangelis@iss.it.

Chiara Panato, Email: chiara.panato@cro.it.

Carlotta Buzzoni, Email: c.buzzoni@ispo.toscana.it.

Riccardo Capocaccia, Email: Riccardo.Capocaccia@istitutotumori.mi.it.

Silvia Francisci, Email: silvia.francisci@iss.it.

Anna Gigli, Email: anna.gigli@irpps.cnr.it.

Manuel Zorzi, Email: manuel.zorzi@regione.veneto.it.

Giovanna Tagliabue, Email: Giovanna.Tagliabue@istitutotumori.mi.it.

Diego Serraino, Email: serrainod@cro.it.

Fabio Falcini, Email: fabio.falcini@irst.emr.it.

Claudia Casella, Email: claudia.casella@hsanmartino.it.

Antonio Giampiero Russo, Email: agrusso@ats-milano.it.

Fabrizio Stracci, Email: fabs@unipg.it.

Bianca Caruso, Email: b.caruso@ausl.mo.it.

Maria Michiara, Email: michiara@ao.pr.it.

Anna Luisa Caiazzo, Email: a.caiazzo@aslsalerno.it.

Marine Castaing, Email: marinecastaing@hotmail.com.

Stefano Ferretti, Email: stefano.ferretti@unife.it.

Lucia Mangone, Email: lucia.mangone@ausl.re.it.

Giuseppa Rudisi, Email: registrotumoripalermo@unipa.it.

Flavio Sensi, Email: fsensi@aslsassari.it.

Guido Mazzoleni, Email: guido.mazzoleni@asbz.it.

Fabio Pannozzo, Email: f.pannozzo@ausl.latina.it.

Rosario Tumino, Email: rtumino@tin.it.

Mario Fusco, Email: mariofusco2@virgilio.it.

Paolo Ricci, Email: paolo.ricci@aslmn.it.

Gemma Gola, Email: gola@asl.como.it.

Adriano Giacomin, Email: adriano.giacomin@aslbi.piemonte.it.

Francesco Tisano, Email: rtp@asp.sr.it.

Giuseppa Candela, Email: registro.tumori@asltrapani.it.

Anna Clara Fanetti, Email: ac.fanetti@ats-montagna.it.

Filomena Pala, Email: epiprosal@aslnuoro.it.

Antonella Sutera Sardo, Email: epidemiologia@libero.it.

Massimo Rugge, Email: registro.tumori@regione.veneto.it.

Laura Botta, Email: Laura.Botta@istitutotumori.mi.it.

Luigino Dal Maso, Email: dalmaso@cro.it, Email: epidemiology@cro.it.

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Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Data Availability Statement

Dataset supporting our findings is available, according to AIRTUM guidelines, at the following website: www.registri-tumori.it.

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